Valvular Heart disease in people over 65
Both the incidence (number of new cases reported in a population over a certain period of time) and prevalence (percentage of the population affected with a particular condition at a given time) of valvular heart disease increases with increasing age.
As with other conditions in older people, the existence of other pathology can confuse the issue, (as far as diagnosis is concerned) and the older person may present with heart failure, palpitations, dizziness, falls, breathlessness, angina, fainting or collapse.
Valvular heart disease is a disease of ageing and most people over the age of 70 show symptomatic evidence of valve dysfunction and around 10% show evidence of significant disease; the process is likely to have begun earlier than that (from the age of 60).
Senile degeneration can be a cause of both valve stenosis and valve regurgitation (incompetence). However, in older people who suffered from rheumatic fever (without the benefit of antibiotics), mitral valve regurgitation, mitral valve stenosis, aortic valve regurgitation, aortic valve stenosis and tricuspid valve stenosis may result (with often more than one valve being affected).
Tricuspid valve regurgitation is often associated with a severe, longstanding lung disorder and is therefore more likely to occur in older people.
Aortic Valve Stenosis
In the Western world, aortic valve stenosis is mainly a disease of older people as the pathological process involves scarring and calcification in the cusps of the valve. It normally presents in a person’s 70’s or 80’s. Aortic valve stenosis is a common cause of fainting, angina and heart failure in older people and there is a real risk of sudden death on exertion.
Coronary Artery disease and Valvular Heart disease
20% of people with aortic regurgitation have coronary artery disease. A common cause of mitral regurgitation is a myocardial infarction, where the papillary (supporting) muscles of the mitral valve are damaged.
Surgery in Valvular Heart disease
Surgery can take place even in the very elderly with a great deal of benefit but because of the likelihood of reduced health, strength and resilience and the possible presence of other disease conditions, the mortality risk may be higher.
If valve replacement surgery is undertaken, a biological valve may be preferable to use in an older person for two reasons:
- It is likely to last the patient’s lifespan,
- There is no need for the use of anticoagulants (the use of which requires careful monitoring and which have potentially serious side effects).
The person may be too frail to be a candidate for surgical valve replacement and drug therapy may alleviate symptoms to some extent.
